Welcome. I'll bet we'd all agree that worry and anxiety are part of life. One way or another we learned to live with a certain degree of anxiety, but life with serious and life-limiting illness can take anxiety to another level. How common is high anxiety in palliative care? Studies show that significant anxiety affects many patients who are candidates for palliative care. High anxiety can negatively impact a patient's ability to make decisions, decrease their satisfaction with the care they receive, worsen their experience of symptoms related to illness and diminished quality of life. Serious illness is often experienced as a series of crisis points around diagnosis, tests, side effects, symptoms, surgeries and losses. Each crisis brings uncertainty and can raise anxiety. Even when things are going well during an illness experience, patients and families may worry about what the next crisis will be, and when it will happen. In those relatively quiet moments, they may also have more time to think about their fears. In palliative care it's important to look for signs of anxiety throughout the illness experience. Here's one definition of anxiety. Like pain, we might practically define anxiety as whatever the person says it is, what makes one person anxious or fearful won't affect someone else the same way. This is because anxiety is often experienced in subtle ways. Asking someone, "Are you anxious?", isn't as helpful as noticing the signs of anxiety in a person's words, emotions, body language and behavior. Let's consider the words people used. I asked you to read Dr. Elana Miller's blog about her feeling of anxiety, about living with cancer. You may have noticed that Dr. Miller said she had anxiety and she described her feelings of anxiety using other words and phrases. If you've taken our introduction to palliative care course, you'll recall that one of the SNAP skills for effective communications is letting the other person guide the conversation. One way we let the other person guide, is to use the words they prefer. Most people don't call anxiety by name, here are examples of ways people might talk about feeling anxious. You should use whatever words they use. For example, if a person says, "I get so tense." You can ask questions like, "When you're tense, how does that show up in your body?" Or, "When you noticed you were tensed were you thinking about anything particular?" I've provided you with optional readings that offer quotes from people describing their feelings of anxiety without using that word. I wanted you to see the many different ways people talk about these feelings. People may find that anxious thoughts are difficult to control. A patient might say, "I just can't stop thinking about my cancer," or a family member may report that she's unable to sleep because she's focused on the patient's coming death. Thoughts may range from unpleasant to catastrophic. Catastrophic describes when a person is focused on the worst possible outcome. Sometimes people describe physical symptoms of anxiety, such as stomach ache, vague pain, heart palpitations, restlessness or the inability to sleep. You're likely thinking that these symptoms could be related to the disease, medications or treatments, and you're right. You'll need to be sure these physical sources of suffering, are not being confused with anxiety. You may see anxiety expressed through a person's behavior, for example they may have a hard time sitting still or they may have panic attacks. A patient, a family member may constantly call or email you, or other health care providers with questions and never be satisfied, they have enough information to cope with illness experience. High anxiety around needles, claustrophobia or other fears, may limit a person's ability to tolerate needed health care procedures. Social anxiety can negatively impact communication with the healthcare team. When the patient becomes the center of attention, this can be an uncomfortable experience for a person who suffers from social anxiety. Some people are more likely to be anxious than others, this is true of people who have a history of diagnosed anxiety or trauma. When anxiety is part of the person's usual coping style, when people lack strong social support and when they must fill many roles in life. By that, I mean they may work, be a parent, help siblings, care for parents, be a leader in the community and so on. You may need to ask family members about the patient's history. Of course, some anxiety in palliative care patients and families is normal, it can even be a helpful response, when it prompts patients to follow treatment plans, or make life changes that improve their quality of life during the illness experience. As palliative care providers, we went to recognize when anxiety may interfere with their ability to function and the quality of life. In the next video, we'll talk specifically about death anxiety.